The State’s leading organ transplant practitioners have warned that the service is reaching a crisis that could end in facilities such as kidney dialysis being rationed or denied altogether to the old and infirm.

David Hickey, director of the National Kidney and Pancreas Transplant Programme, told the Oireachtas Committee on Health and Children that renal failure management had the potential “to bankrupt health services” in the western world over the next 20 years.

Mr Hickey said if the issue was not addressed “we are going to be talking about rationing dialysis in the not too distant future”.

He said this could apply to those who were deemed to be not productive members of society, including “people like me, the over-60s”, the very young or the “mentally retarded perhaps”.

He said this was already happening in countries which could not sustain themselves with dialysis services, “the Indias, the Pakistans, the Israels of this world”, where the only alternative was to “go abroad and buy kidneys because there was no alternative apart from dying”.

Mr Hickey said the best possible outcome was for more donors to become available as those who received a kidney from a living donor could expect to live twice as long as those on dialysis.

The committee heard from solicitor JP McDowell of McDowell Purcell solicitors that the Government proposed to introduce a new Bill to introduce the concept of “presumed consent”. This would presume the consent of a person to donate organs after death. However, Mr Hickey and a range of medical experts questioned the usefulness of this as they argued they could not presume consent to overrule the wishes of the family of a potential donor.

Prof Peter Conlon said organ procurement was run “on a shoestring in Ireland”.